Residents as Teachers: Benefits of Creating Infographics

Accreditation Council for Graduate Medical Education (ACGME) requirements emphasize resident teaching as a component of professionalism.¹ Residents usually develop teaching skill² via a “see one, do one, teach one” approach, accompanied by the assumption that teaching capability signifies mastery.^2-4 Many teaching curricula rely on implicit learning from exposure to teaching encounters, without explicit instruction on teaching best practices or discussing teaching within professional identity. Resident learners have few formal opportunities to reflect on teaching.

There is sparse scholarship examining the impact of specific assignments on teaching identity, particularly in programs without a formal “resident as teacher” curriculum. We developed an infographic assignment for residents. Infographics have become an important, evidence-based modality for delivering information.⁵ Infographics condense content and use visual-spatial organizers to facilitate learning. Developing an infographic requires active engagement, similar to other forms of experiential learning and reflection.⁶ Medical learners and teaching faculty can utilize infographics to review complex information, making them useful just-in-time teaching tools for busy clinical environments.⁷ Our qualitative study used semistructured interviews to explore the impact of this innovative infographic assignment on residents’ teaching practices and their thinking about teaching.

First- and second-year family medicine residents had 2 weeks to complete an infographic assignment about a topic of their choosing. Residents received in-person instruction at the beginning of the rotation in how to construct an infographic.⁸ Some residents sought coaching depending on whether they hoped to use their infographic with patients or peers. Author C.H. conducted, recorded, and transcribed the 14 interviews. One resident participated in the interview both first and second year, resulting in seven year-1 interviews and seven year-2  interviews. Seven of the residents identified as female, five as male. At the end of their behavioral health rotation, residents participated in a recorded interview about their project and ideas about teaching.^8,9 Residents received formative feedback about their infographic from C.H. after their interview.

Transcripts were developed from Microsoft Teams (Microsoft Corp, Redmond, WA) closed captioning and verified by reviewing draft transcripts while rewatching videos.

This study was deemed exempt by the institutional review board at Western Michigan University Homer Stryker M.D. School of Medicine.

We analzyed deidentified transcripts using applied thematic analysis.¹⁰ We discussed preliminary codes. Similar codes were combined into themes. After five interviews, coders suggested additional questions for subsequent interviews to elaborate on emerging themes. Saturation¹¹ emerged after 14 interviews. All transcripts were read by all authors and coded iteratively by two faculty (K.A.P.S. and A.C.) without connection to the residency program. All authors met regularly and came to consensus on the final themes. Strategies for validating the findings included investigator triangulation, reflexivity, and having a diverse study team including a clinical psychologist, medical science educator, and general science educator.

Thematic analysis of transcripts resulted in five themes, providing insight into residents’ infographic process and its impact on perceptions of teaching. Example quotations are shown in Table 1.

To make the infographic, residents needed to find relevant medical literature on their topic. Finding and reading such material benefited the resident as a teacher and learner. The research process helped them affirm their knowledge of the subject and evaluate the quality of the data that inform practice.

Multiple residents experienced the difficulty of identifying the key points and eliminating unnecessary detail. Residents described the importance of distilling medical information into an essential message.

Some residents commented that they spent time finding or creating informative, clear figures for their infographics. They understood that a good infographic should be visually appealing to support the educational content. Related to Theme 2, creating bullet points instead of large blocks of text contributes to the aesthetics and educational value of the infographic.

Most residents recognized that teaching patients is an integral part of family medicine. Most identified their primary teaching audience as patients. Only a few residents commented on teaching medical students and other residents. Few residents expressed interest or comfort in teaching their infographic to faculty, consistent with the traditional hierarchy of medicine and their own insecurities.

Consistent with their stage of training, most residents did not have well developed teaching philosophies. For example, in response to the question, “Do you have a teaching philosophy?”, a resident responded, “I’m not really sure.” A few residents explained their approach to teaching.

Residents noted benefit from developing infographics. Consistent with the above themes, residents indicated that the assignment helped them integrate knowledge, set priorities, practice conciseness, and tailor information for an audience. Many found value in creating an aesthetic that helped integrate their teaching points. Most saw a role for teaching with patients. Few had considered their teaching practices formally.

Conclusions drawn from this scholarship should be considered within the limitations of qualitative work generally. We interviewed a sample of family medicine residents who delivered feedback from their unique perspectives. While in-depth, qualitative reactions may be valuable in evaluation of curriculum, they fall under Kirkpatrick level 1 evidence.

Residents are early in their teaching journey. They have neither thought much about nor had significant formal training in teaching. Communication skills and patient care strategies are rarely framed in terms of teaching, even though relationship building, communication, and motivation are central to patient care and teaching. Without explicit prompts and examples, residents and other learners may fail to translate these concepts into a cohesive philosophy for teaching outside of their pragmatic skills for patient care. Curricular interventions such as this infographic assignment can promote these skills and prompt intentional conversations.

Residency is a developmental process; tasks should have a developmental progression.^12,13 Residents would benefit from more explicit instruction about teaching throughout residency. Given the reliance on resident physicians to teach, curricula focused on teaching practices could enhance teaching and learning.⁴ This study demonstrates that infographic development can be useful for family medicine residents to grow their teaching skills.